Emergency Child ID Record

A private record of important information to be given to authorities should the need arise.

Child’s Name: __________________________________

Keep Readily Available in a Safe Location
Document provided courtesy of

Assemblyman
David G. McDonough




Personal Information



Name (last)



(first)



(middle)

Attach
most
recent
photo
here.



Nickname




Date of Birth

Social Security Number



Mother’s Name




Phone

Social Security Number



Father’s Name




Phone

Social Security Number



Street




City

State

Zip


Fingerprints Most Police Departments will fingerprint your child for free.

right thumb right index right middle right ring right little
left thumb left index left middle left ring left little


Medical Information



Doctor’s Name


Phone


Birth Hospital


City, State


Phone

M  F
Sex



Blood Type


Race


Complexion


Eye Color


Hair Color


Height


Weight


Shoe Size


Clothing Size

Yes  No
Glasses?

Yes  No
Braces?


Chronic Illnesses


Medications


Allergies


DNA Sample

Dental Records
Have your child’s dentist complete this section.


Dentist’s Name


Phone

Dental Records


Child’s Favorite Things




Places











Foods











Pastimes











Other Identifying Activities, Mannerisms, etc.










It is my sincere hope that this document is never needed, but that completing it may offer some peace of mind to parents and guardians.

If you would like more copies, please do not hesitate to contact my offices:

404 Bedford Avenue • Bellmore, NY 11710 • (516) 409-2070 or
533 Legislative Office Building • Albany, NY 12248 • (518) 455-4633
e-mail: mcdonoughd1@assembly.state.ny.us

— Assemblyman David G. McDonough


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